The Effects of Mastery on Pain and Fatigue Resolution

Elizabeth A. Byma

Barbara A. Given

Charles Given

Mei You

pain, fatigue
ONF 2009, 36(5), 544-552. DOI: 10.1188/09.ONF.544-552

Purpose/Objectives: To determine whether mastery, the personal control felt over occurrences perceived to have an important effect on one's life, influences the resolution of pain and fatigue severity.

Design: Secondary data analysis of two randomized clinical trials.

Setting: Accrual from two comprehensive cancer centers, one community oncology program, and six hospital-affiliated ambulatory oncology centers.

Sample: 330 patients with solid tumors who were undergoing chemotherapy and receiving a nurse-presented, six-contact, eight-week intervention for symptom management.

Methods: Analysis included baseline and interventional data. Logistic regression and survival analysis methods were used to explain relationships between mastery and time to resolution and resolution of pain and fatigue severity.

Main Research Variables: Mastery, pain and fatigue severity resolution, and time to resolution.

Findings: No significant differences in mastery were found among key socioeconomic and cancer-related variables. Mastery was a significant predictor of pain resolution status but did not significantly decrease time to resolution. Mastery did not have a significant effect on fatigue resolution status or time to fatigue resolution after adjusting for other covariates.

Conclusions: Mastery was symptom specific, predicting pain resolution but not fatigue. Cancer may have an equalizing effect on mastery early in diagnosis and treatment.

Implications for Nursing: Nurses should develop interventions that increase mastery in patients with cancer, which may lead to improved resolution of pain. Additional research is needed to explore how mastery may affect resolution of pain severity and other symptoms experienced by people with cancer.

Jump to a section


    American Pain Society. (2005). Guideline for the management of cancer pain in adults and children. Glenview, IL: Author.
    Antoni, M.H., Lehman, J.M., Kilbourn, K.M., Boyers, A.E., Culver, J.L., Alferi, S.M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20-32.
    Arnold, R., Ranchor, A.V., Koeter, G.H., de Jongste, M.J., Wempe, J.B., ten Hacken, N.H., et al. (2006). Changes in personal control as a predictor of quality of life after pulmonary rehabilitation. Patient Education and Counseling, 61(1), 99-108.
    Avison, W.R., & Cairney, J. (2003). Social structure, stress, and personal control. In S.H. Zarit, L.I. Pearlin, & K.W. Schaie (Eds.), Personal control in social and life course contexts (pp. 127-164). New York: Springer.
    Cairney, J., & Krause, N. (2008). Negative life events and age-related decline in mastery: Are older adults more vulnerable to the control-eroding effect of stress? Journal of Gerontology, 63(3), S162-S170.
    Carver, C.S., Harris, S.D., Lehman, J.M., Durel, L.A., Antoni, M.H., Spencer, S.M., et al. (2000). How important is the perception of personal control? Studies of early stage breast cancer patients. Personality and Social Psychology Bulletin, 26(2), 139-149.
    Dobson, K.S., & Dozois, D.J. (2001). Historical and philosophical bases of the cognitive-behavioral therapies. In K.S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (2nd ed., pp. 3-39). New York: Guilford Press.
    Dodd, M.J., Janson, S., Facione, N., Faucett, J., Froelicher, E.S., Humphreys, J., et al. (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33(5), 668-676.
    Dodd, M.J., & Miaskowski, C. (2000). The PRO-SELF program: A selfcare intervention program for patients receiving cancer treatment. Seminars in Oncology Nursing, 16(4), 300-314.
    Doorenbos, A.Z., Given, B., Given, C., & Verbitsky, N. (2006). Physical functioning: Effect of behavioral interventions for symptoms among individuals with cancer. Nursing Research, 55(3), 161-171.
    Fallon, M. (2005). The current situation with cancer pain. In D.M. Justins (Ed.), Pain 2005: An updated review (pp. 165-169). Seattle, WA: International Association for the Study of Pain.
    Given, B., Given, C.W., McCorkle, R., Kozachik, S., Cimprich, B., Rahbar, M.H., et al. (2002). Pain and fatigue management: Results of a nursing randomized clinical trial. Oncology Nursing Forum, 29(6), 949-956.
    Given, B., Given, C.W., Sikorskii, A., Jeon, S., McCorkle, R., Champion, V., et al. (2008). Establishing mild, moderate, and severe scores for cancer-related symptoms: How consistent and clinically meaningful are interference-based severity cut points? Journal of Pain and Symptom Management, 35(2), 126-135.
    Given, C., Given, B., Rahbar, M., Jeon, S., McCorkle, R., Cimprich, B., et al. (2004). Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. Journal of Clinical Oncology, 22(3), 507-516.
    Katz, J.N., Chang, L.C., Sangha, O., Fossel, A.H., & Bates, D.W. (1996). Can comorbidity be measured by questionnaire rather than medical record review? Medical Care, 34(1), 73-84.
    Kurtz, M.E., Kurtz, J., Stommel, M., Given, C.W., & Given, B.A. (2001). Physical functioning and depression among older persons with cancer. Cancer Practice, 9(1), 11-18.
    Kurtz, M.E., Kurtz, J.C., Given, C.W., & Given, B.A. (2008). Patient optimism and mastery—Do they play a role in cancer patients' management of pain and fatigue? Journal of Pain and Symptom Management, 36(1), 1-10.
    McLeod, J.D. (2003). Social aspects of stress: Networks, choices, and values. In S.H. Zarit, L.I. Pearlin, & K.W. Schaie (Eds.), Personal control in social and life course contexts (pp. 173-188). New York: Springer.
    Mystakidou, K., Tsilika, E., Parpa, E., Katsouda, E., Galanos, A., & Vlahos, L. (2006). Psychological distress of patients with advanced cancer: Influence and contribution of pain severity and pain interference. Cancer Nursing, 29(5), 400-405.
    National Cancer Institute. (2006). Pain (PDQ®) [Electronic version]. Retrieved June 8, 2008, from
    Pearlin, L.I., Menaghan, E.G., Lieberman, M.A., & Mullan, J.T. (1981). The stress process. Journal of Health and Social Behavior, 22(4), 337-356.
    Pearlin, L.I., & Pioli, M.F. (2003). Personal control: Some conceptual turf and future directions. In J.M. Zarit, L.I. Pearlin, & K.W. Schaie (Eds.), Personal control in social and life course contexts (pp. 1-22). New York: Springer.
    Pearlin, L.I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19(1), 2-21.
    Pudrovska, T., Schieman, S., Pearlin, L.I., & Nguyen, K. (2005). The sense of mastery as a mediator and moderator in the association between economic hardship and health in later life. Journal of Aging and Health, 17(5), 634-660.
    Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C.M. (2003). Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. Journal of Consulting and Clinical Psychology, 71(1), 189-200.
    Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.
    Reyes-Gibby, C.C., Aday, L.A., Anderson, K.O., Mendoza, T.R., & Cleeland, C.S. (2006). Pain, depression, and fatigue in community-dwelling adults with or without a history of cancer. Journal of Pain and Symptom Management, 32(2), 118-128.
    Ross, C.E., & Sastry, J. (1999). The sense of personal control. In C.S. Aneshensel & J.C. Phelan (Eds.), Handbook of the sociology of mental health (pp. 369-394). New York: Kluwer Academic/Plenum Publishers.
    Seeman, T.E. (1999). Personal control. Retrieved June 7, 2008, from
    Sherwood, P., Given, B., Given, C., Champion, V.L., Doorenbos, A.Z., & Azzouz, F. (2005). A cognitive behavioral intervention for symptom management in patients with advanced cancer. Oncology Nursing Forum, 32(6), 1190-1198.
    Sherwood, P., Given, B., Given, C., Schiffman, R., Murman, D., von Eye, A., et al. (2007). The influence of caregiver mastery on depressive symptoms. Journal of Nursing Scholarship, 39(3), 249-255.
    Volker, D.L., Kahn, D., & Penticuff, J.H. (2004a). Patient control and end-of-life care, part I: The advanced practice nurse perspective. Oncology Nursing Forum, 31(5), 945-953.
    Volker, D.L., Kahn, D., & Penticuff, J.H. (2004b). Patient control and end-of-life care part II: The patient perspective. Oncology Nursing Forum, 31(5), 954-960.